From the Research
Methylprednisolone may cause fewer side effects than prednisone, particularly in terms of sodium and fluid retention, due to its lower mineralocorticoid activity, as suggested by the study published in the British journal of rheumatology 1.
Key Points to Consider
- Both methylprednisolone and prednisone are corticosteroids with similar mechanisms of action and can cause similar adverse effects, including fluid retention, weight gain, elevated blood pressure, increased blood sugar, mood changes, insomnia, increased appetite, and with long-term use, osteoporosis, muscle weakness, cataracts, and adrenal suppression.
- The study published in the British journal of rheumatology 1 found that intramuscular methylprednisolone acetate (i.m. MP) was associated with far fewer fractures and lesser weight gain compared to oral prednisolone (OP) in the treatment of polymyalgia rheumatica, possibly due to the lower cumulative dose of methylprednisolone.
- The dosing equivalence between methylprednisolone and prednisone is important to note, with 4 mg of methylprednisolone being approximately equivalent to 5 mg of prednisone in anti-inflammatory potency.
- The choice between these medications typically depends on specific clinical situations, physician preference, and sometimes cost or availability rather than side effect profiles.
- For any patient taking either medication, the risk of side effects increases with higher doses and longer duration of treatment, making the lowest effective dose for the shortest necessary time the best approach to minimize adverse effects.
Clinical Implications
- When deciding between methylprednisolone and prednisone, clinicians should consider the potential benefits of methylprednisolone's lower mineralocorticoid activity, particularly in patients with heart failure or hypertension.
- However, the difference in side effect profiles between the two medications is generally modest in clinical practice, and the choice between them should be based on individual patient needs and clinical situations.
- The study published in the European journal of pediatrics 2 found that methylprednisolone therapy was as effective as high-dose prednisone in patients with relapse of systemic lupus erythematosus nephritis, with minimal side effects, suggesting that methylprednisolone may be a viable alternative to prednisone in certain clinical situations.